while recognizing that interventions outside the health sector, such as investments in the quality and coverage of education for girls, also generate important health benefits.


Data on health expenditures, particularly on private out-of-pocket expenditures and on local and provincial public expenditures on health (in contrast to central-level spending) are quite weak in many developing countries. We draw here on World Bank (1993) estimates of the level of spending, activity, and source of finance based on information from government budgets and national accounts, household surveys, and estimates made by international organizations, supplemented by estimates predicted by an imputation model for countries for which direct data are unavailable.

In the world as a whole, an estimated $1.7 trillion was spent on health care from all sources in 1990: about 10 percent, or $170 billion, was spent in developing countries, although about 78 percent of the world's population live in those countries. Two regularities characterize health expenditures across countries. First, as a country's average income level increases, so does the percentage of income spent on health: developing countries spend on average 4.7 percent of their gross national product (GNP) on health; in established market economies, the figure is 9.2 percent. Second, as incomes rise, the share of spending that is public also tends to increase: in developing countries about 50 percent of all spending is public; in established market economies, this share is 60 percent (World Bank, 1993).

Health spending by region varies from as low as $11 per person in China to more than $1,800 per person in established market economies; see Table 7-1. There is also large variation within regions. Tanzania and Ethiopia, for example, spend only about $4 per capita on health, about one-half of which is public ($2 per capita), while spending in South Africa is almost $160 per capita. Such variation among countries in levels of expenditure means that there is no single set of near-term recommendations for reproductive health programs that is realistic in all settings.

No available estimates cover reproductive health as a whole, but some estimates exist for public-sector spending on maternal and child health and family planning; see Table 7-2. These expenditures accounted for about 6 percent of public-sector health expenditures in 1990. The expenditures on family planning varied among the countries shown in Table 7-2 more than ten-fold, from less than (U.S.) $0.10 per person per year in Ghana, Lesotho, and Mauritania to more than $1.00 in El Salvador. No comparable data exist on private spending or on the other types of reproductive

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